Provider Demographics
NPI:1881443380
Name:SANDRALI, SEBAKARA
Entity type:Individual
Prefix:
First Name:SEBAKARA
Middle Name:
Last Name:SANDRALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 S MILL AVE
Mailing Address - Street 2:SUITE 160, MAILBOX #150
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6758
Mailing Address - Country:US
Mailing Address - Phone:757-652-7262
Mailing Address - Fax:
Practice Address - Street 1:4600 S MILL AVE
Practice Address - Street 2:SUITE 160, MAILBOX #150
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6758
Practice Address - Country:US
Practice Address - Phone:757-652-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSLG13273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health